Long-term therapeutic outcomes of facial arteriovenous malformations: A retrospective bi-centric study of 30 cases

Among vascular malformations, arteriovenous malformations (AVM) are potentially the most invasive and destructive especially when located on the face. Their management is still subject to controversy and yet no consensus exists. Our aim was to report long-term therapeutic outcomes for patients with facial AVM managed either by embolization alone or by resection with/without preoperative embolization. A bi-centric retrospective study was carried out covering the period from 2001 to 2018 including 30 patients with a facial AVM. Outcomes were categorized as follows: with 1=controlled disease, 2=improved disease (residual, no expansion), 3=persistent or stable disease (neither improved nor worsened), and 4=recurrent or worsened disease. The initial treatment modality was embolization (n=5, 16.7%), surgical resection (n=16, 53.3%), and surgical resection after embolization (n=9, 30%). The follow-up period ranged from 12 to 216 months with a median of 54.9 months. Taking all treatment modalities together, disease control was achieved in 60% of the cases. Disease control was achieved in 77.8% of the cases after embolization followed by surgery, in 68.7% after surgery alone and in none of the cases after embolization alone. According to our results, optimal treatment is based on a combination of embolization followed by a well-conducted surgical treatment. Les malformations artérioveineuses (MAV) sont des malformations vasculaires constituées d’artères et de veines interconnectées sans lit capillaire intermédiaire. Quoique rare, leur localisation faciale peut mettre en jeu le pronostic esthétique et fonctionnel mais aussi vital. À ce jour, il n’existe aucun consensus pour la prise en charge de ces lésions et aucune thérapeutique n’a fait la preuve de sa supériorité. Le but de ce travail était d’évaluer les résultats thérapeutiques auprès des sujets traités d’une MAV faciale. Il s’agissait d’une étude rétrospective bi-centrique réalisée entre 2001 et 2018 incluant 30 patients traités d’une MAV de la face. Les résultats thérapeutiques étaient classés comme suit : 1=contrôle de la maladie, 2=amélioration la symptomatologie, 3=persistance de la symptomatologie sans amélioration ni aggravation, 4=récidive ou aggravation de la maladie. Le traitement de la MAV était la chirurgie seule chez 16 patients (53,3 %), l’embolisation seule chez 5 patients (16,7 %) et l’embolisation suivie de la chirurgie chez 9 patients (30 %). Le recul moyen était de 54,9 mois avec des extrêmes